Laurie's comments address the critically important issue of safe
feeding for non-breastfed infants. I agree that a breastfeeding class
need not give more time to other kinds of feeding than 'that is
something you need individual guidance on when the time draws nearer'.
People who think they have been taught everything they need to know
about ANYTHING in a group session on day 2 of their child's life, are
mistaken.  Far better for them to have been told 'we don't have the
time to do that topic justice in this breastfeeding class - it is
complicated and you should have an individual session to ensure that
you can feed your baby safely if you are relying on formula'  or
'bottle feeding is a separate topic from breastfeeding, we have
information available on line at ....'  or some such thing.

Part of Baby-Friendly is making sure all babies are fed safely. That
includes babies who aren't getting breastfed. I know the argument can
be made that artificial feeding is by nature unsafe but it is denying
reality to think that all artificial feeds will cease to exist if we
just pretend hard enough.  But the breastfeeding class is NOT the
place to teach about bottle feeding or about how to prepare and give
formula feeds safely, for all the reasons Heather cites (normalizing
bottle and artificial feeding as a natural part of breastfeeding, and
pedagogically inappopriate in its timing and method).

Laurie reports 'creative' ways to prepare formula feeds she has
observed in Mississippi.  I see the same things here in Norway, and
ready-to-feed formula is the exception, not the rule. Parents almost
always use powder and our hospital does too.  I am trying to change it
but things move slowly. No other health professionals in my area have
ever heard that ready-to-feed is preferable to home-mixed powder for
the youngest or most vulnerable babies.  I am not aware that there are
national Norwegian guidelines for what parents should be taught in the
event they will be feeding formula. They may exist but they are not
high profile if so, and teaching is haphazard at best.

As a postpartum midwife I have an obligation to see to it that parents
have the necessary information and skills to care for their babies
safely.  As an IBCLC I am not really qualified to teach about formula
preparation, but I am eminently qualified to talk about how to to feed
a bottle in a way that has some of the important elements of baby's
experience breastfeeding, because I know the nature of breastfeeding.
Someone who only knows artificial feeding will not have the same
valuable information to transmit.  It's a joke to think that telling
parents who have never experienced normal, happy breastfeeding will
find any meaning in the exhortation to 'make the bottle feed as much
like breastfeeding as possible', yet this is what they are told.

I do a LOT of teaching about bottle use and about formula use when I
work with individual postpartum mothers.  I don't do it in groups
because it's inappropriate where I am.  I do wish we had clearer
mandates about what to teach women who aren't breastfeeding, because
in my opinion Norwegian babies who are not breastfed are not given
safe enough care now, but I would not gather their mothers in a group
on the ward to teach them.

We've got an internet forum for bottle feeding mothers in Norway,
started by two mothers whose babies were unable to breastfeed in the
beginning. They took the responsibility the health services neglected
to take - they have a non-commercial information site about different
kinds of bottles, about paced bottle feeding, safe preparation of
artificial feeds, and a group forum to support other mothers
emotionally.   The breastfeeding organization links to their site and
vice versa.  I'm really glad we have avoided the polarization that
characterizes the discussion in many other countries, because it
allows mothers to support each other.  What's not to love?

Rachel Myr
Kristiansand, Norway

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